LAPORAN PEMERIKSAAN EXCAVATOR

Jenis Operator / Sopir

Merk / Type / SIM Polisi
Kode Berlaku s.d
HM / KM Helper
No. Polisi / Tanggal Periksa
Serial Number )* Lokasi Periksa

Keterangan kondisi : B (Baik), R (Rusak), TA (Tidak Ada), N/A (Tidak tersedia), C (Cek) diisi dengan tanda ( V )
HASIL HASIL
BAGIAN YANG DIPERIKSA BAGIAN YANG DIPERIKSA
B R TA N/A C B R TA N/A C
ENGINE HYDRAULIC
Air Cleaner & Connection Armor
Aircleaner + Vacuator Valve Hydraulic Hose
Belt Tension Hydraulic pump
Engine Condition Hydraulik Press Relief ( 357 kg / cm2 )
Engine High Indle Rpm ( 2140 rpm ) Hydraulik Tank
Engine Oil Pan Rod Clyinder Masking
Exhaust Pipe
Fuel Tank BODY WORK & CABIN
Lubricate Following Lubrication Chart Ashtray
Pre Cleaner BOOM, Arm, Bucket / Graple
Racor Bucket
Radiator Caps ( Semua Tutup Tangki )
Radiator Core & Connection Door Lock
Sediment in Fuel Filter & Tank Mirror
Staring Motor Operator Seat
Starting Key no. ………. Rubber Floor Mate
Unusual Nolses Seat Belt
Water Sub Tank Radiator Sticker Set
Track Rollers & Indlers
TRANSMISSION & STEERING Track Tension
Chrottle & Control Levers Washer Wiper Tank
Final Drive Case
Swing Circle
Swing Lock and Brake
Swing Machinery

ELECTRICAL PERSYARATAN K3
Air Conditioner 1 Kebersihan
Altenator 2 Sepatu Safety
Battery Electrolyte 3 Pakaian Kerja
Cabin Lamp 4 Helm
Head Lamp 5 APAR ( Racun Api )
Horn 6 Obat untuk P3K
Monitor Panel & Switchs Function 7 Safety Belt
Radio, Speakers, Antena
Refill Fuel Pump LAIN - LAIN
Smoke ligther 1 Data Maintenance
Travell Alarm
Wiper + Nozle

Kesimpulan : Alat Berat / Kendaraan & Operator / Sopir tersebut Ya / Tidak *(coret salah satu) dapat beroperasi

Catatan Hasil Pemeriksaan Diketahui Oleh:

Diperiksa Oleh: